Healthcare Provider Details

I. General information

NPI: 1316789506
Provider Name (Legal Business Name): TRINITY WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82424 CADIZ JEWETT RD
CADIZ OH
43907-9427
US

IV. Provider business mailing address

380 SUMMIT AVENUE MSO PHYSICIAN BILLING
STEUBENVILLE OH
43952-2667
US

V. Phone/Fax

Practice location:
  • Phone: 740-320-4048
  • Fax: 740-652-6477
Mailing address:
  • Phone: 740-283-7776
  • Fax: 740-283-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID ANTHONY WERKIN
Title or Position: CFO
Credential:
Phone: 740-264-8110